Unique Thompson
Houston,TX
Summary
Detail-oriented and organized Claims Specialist with extensive experience in assessing and processing insurance claims with precision and efficiency. Skilled at evaluating policy coverage, conducting thorough investigations, and negotiating settlements while ensuring compliance with regulations and company standards. Solid work ethic drives consistent achievement of accurate and timely claim resolutions, minimizing errors and maximizing customer satisfaction.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Claims Specialist
GEICO
11.2024 - Current
- Investigate and process auto insurance claims, assessing liability and coverage to ensure accurate and timely resolution.
- Collaborate with policyholders, claimants, medical providers, and legal representatives to gather relevant documentation and information.
- Evaluate damages, interpret policy language, and negotiate settlements in accordance with company procedures and state regulations.
- Utilize claims management software to document case progress, communications, and final determinations while maintaining detailed records.
- Provide outstanding customer service, guiding claimants through the claims process with empathy and professionalism.
- Mitigate risk and control expenses by identifying fraudulent or exaggerated claims and escalating when necessary.
- Maintain compliance with all legal and regulatory requirements while upholding company standards for performance and ethics.
Claims Adjuster
TD Insurance
05.2024 - 11.2024
- Analyzed, evaluated, and processed insurance claims to determine coverage, liability, and damages in accordance with policy terms and state regulations.
- Communicated regularly with claimants via phone calls, emails, or letters regarding status updates or additional documentation requests.
- Handled difficult conversations professionally while maintaining composure during high-stress situations.
Outreach Specialist
Ciox Healthcare
01.2024 - 05.2024
- Processed medical record requests by taking calls from patients, insurance companies, and attorneys to provide medical record status.
- Reviewed, researched, resolved, and responded to inquiries received via telephone, email, or written correspondence.
- Maintained confidentiality by keeping all information seen and heard within boundaries of the role in the strictest confidence.
Collections Specialist
Parallon
01.2023 - 01.2024
- Negotiated with customers to reach payment agreements.
- Demonstrated strong customer service skills while communicating with customers regarding payment arrangements.
- Negotiated payment arrangements with customers to ensure timely resolution of delinquent accounts.
Claims Adjuster
TD Insurance
06.2022 - 12.2022
- Reviewed, evaluated, and adjusted claims to promote fair and prompt settlement on behalf of insurance companies.
- Negotiated and settled claims according to information presented through reports, research, and data verification.
- Aimed to provide clients with the highest level of customer service possible.
- Demonstrated strong problem-solving skills when addressing challenging disputes between parties involved in a claim.
- Monitored claims handling by leveraging calendar management system, completing timely follow-up with all parties.
COVID-19 Screener
MD Anderson Cancer Center Mays Clinic
01.2022 - 06.2022
- Maintained up-to-date knowledge of COVID-19 testing and contact tracing protocols and procedures.
- Offered protective masks and face shields to guests to protect against the virus.
- Completed COVID-19 questionnaires for all people entering the establishment.
- Greeted patients and visitors in an effort to create a warm, welcoming environment.
- Provided patient screening for COVID-19 symptoms, including temperature checks and symptom assessments.
Claims Representative
Monroe Insurance
05.2019 - 12.2020
- Processed and analyzed customer claims with accuracy and attention to detail.
- Maintained accurate records of all communications with customers.
- Utilized effective problem-solving techniques to resolve complex customer issues.
- Successfully resolved escalated claims to ensure customer satisfaction.
Education
Nursing
University of Texas At Arlington, Arlington, TX
Arlington, TXHigh School Diploma -
Shadow Creek High School
Pearland, TX2018
Skills
- Claims Investigation & Processing
- Policy Coverage Evaluation
- Customer Service Excellence
- Negotiation & Settlement
- Regulatory Compliance
- Data Analysis & Reporting
- Communication & Interpersonal Skills
- Time Management & Organization
- Proficiency in Microsoft Office Suite
Certification
- Adjuster - All Lines
Technical Skills
- Microsoft Office Suite (Word, Excel, Outlook)
- Claims Management Software
- Data Entry
- Typing Proficiency
Timeline
Claims Specialist
GEICO
11.2024 - Current
Claims Adjuster
TD Insurance
05.2024 - 11.2024
Outreach Specialist
Ciox Healthcare
01.2024 - 05.2024
Collections Specialist
Parallon
01.2023 - 01.2024
Claims Adjuster
TD Insurance
06.2022 - 12.2022
COVID-19 Screener
MD Anderson Cancer Center Mays Clinic
01.2022 - 06.2022
Claims Representative
Monroe Insurance
05.2019 - 12.2020
Nursing
University of Texas At Arlington, Arlington, TX
High School Diploma -
Shadow Creek High School
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